All across Europe, healthcare professionals in their daily work are today more likely to interact with people or communities expressing different values, behaviours, norms, rituals and concepts of the world. When not addressed properly, such intercultural situations can result in a less-than-ideal professional performance, building a barrier to healthcare provision that may encompass misunderstandings, failure of diagnosis, the refusal of treatment, under-treatment or even maltreatment and discrimination.

To improve the quality of the services it is important that not only the frontline health professionals, but also the managers of health services, VET providers, and decision-makers are able to uncover the set of cultural norms and values which filter the way we interpret and respond to others. From a symmetrical perspective, also social workers working with migrants and migrants themselves could benefit from a greater understanding of diversity from a public health point of view.

The Healthy Diversity project has developed resources to promote an intercultural and holistic approach to medicine through an interesting methodology, which lifting the often negative emotional haze surrounding intercultural misunderstanding, helps to become more aware of the illusion of a cultural neutrality and invites us to open up a margin for negotiation where prejudice has a lesser role to play.

We invite you to the roundtable on intercultural medicine and diversity that will be hosted by CESIE (August 30th, 3pm) to present the Healthy Diversity resources developed for healthcare professionals.

Healthy Diversity

Roundtable on intercultural medicine and diversity

30 August 2018 | h 15-17

CESIE, via Roma, 94 – Palermo

The Healthy Diversity resources offer the chance to step out of your comfort zone and challenge ourselves in relation to our cultural identity and the approach to diversity in our daily work.

Stop being politically correct with yourself, discover your sensitive zones and develop strategies for more conscious and effective intercultural interactions!

The resources in a nutshell

Manual of Critical incidents contains 60 real stories of problematic intercultural interactions in the healthcare sector. The stories were collected through workshops and interviews, and were then analysed through the inspiring Critical Incidents methodology developed by the French social psychologist Margalit Cohen-Emerique.

The Medical Anthropology Reader: a literature review of 12 texts combining medicine, psychology, sociology, anthropology as well as cultural and migration studies.

Good Practice Collection: 20 Good Practices from various types of healthcare institutions across Europe and an Assessment Tool for the implementation and self-assessment of initiatives aimed at the improvement of diversity management and intercultural competences in the healthcare sector.

Face-to-facetraining programme and an online course for healthcare professionals, trainers and managers of healthcare institutions.

For more information

]]>http://healthydiversity.eu/healthy-diversity-roundtable-on-intercultural-medicine-and-diversity-for-healthcare-professionals/feed/0The short story of a beautiful project on diversity in healthcarehttp://healthydiversity.eu/the-short-story-of-a-beautiful-project-on-diversity-in-healthcare/
http://healthydiversity.eu/the-short-story-of-a-beautiful-project-on-diversity-in-healthcare/#respondWed, 08 Aug 2018 14:42:26 +0000http://healthydiversity.eu/?p=2805Dear reader,

during the last three years, the Healthy Diversity partnership has researched and addressed various aspects of diversity and intercultural interactions in the healthcare sector in Austria, Denmark, France, Hungary, Italy, and the UK.

The project activities started with workshops and interviews with healthcare professionals and patients, aimed at collecting individual stories of critical situations arising from interactions with people from a different cultural background.

The stories were then analysed through the Culture Shocks methodology developed by the French social psychologist Margalit Cohen-Emerique, and the final selection of 60 “critical incidents” was categorised and organised in the Manual of Critical incidents. Have a look at the collected stories! have you experienced similar issues?, how did/would you react?

Our journey continued with the research and selection of medical anthropology studies based on multidisciplinar approaches to health and wellbeing. The Medical Anthropology Reader consists in a literature review of 12 texts combining medicine, psychology, sociology, anthropology as well as cultural and migration studies. An interesting reading also for non experts!

Moving to the analysis of the state of the art as to health and diversity from an institutional perspective, in the second year of the project we have also developed a Good Practice Collection consisting of a Collection of 20 Good Practices from various types of healthcare institutions across Europe and an Assessment Tool for implementation and self-assessment of projects and new efforts aimed at the improvement of diversity management and intercultural competences in the healthcare sector. Thus, the Assessment Tool presents concrete examples on how to be exact in the formulation of all stages in the overall chain from implementation to final results and evidence of impact in accordance with success indicators.

After the needs analysis phase, the last part of the project was dedicated to the development of practical training resources for healthcare professionals. This effort eventually resulted in a 3-day face-to-face training programme and an online course, whose main objectives are to:

increase the understanding about internal, contextual and cultural factors affecting individual behaviors and social interactions.

raise awareness about socio-cultural diversity and its relevance for medical and social care practice.

promote intersectional thinking between different health and social care settings.

Besides the tangible project results, the Healthy Diversity project has also allowed 16 healthcare professionals from the partner countries to take part in international mobilitiesand trainings.

The first mobility took place last summer in Palermo (Italy) on occasion of the joint staff training to test the developed training activities, whereas the second group had the chance to participate in the project final event hosted in July by the Hungarian partner in Budapest. It consisted of an international interdisciplinary conference on health and diversity with keynote speakers and roundtables (2-3 July), followed by three days of training.

Lastly, we have had the chance to present the project during many high-level local and international events, amongst them a national conference on intercultural pedagogy at the University of Rome “La Sapienza”, a multi-stakeholder policy roundtable on migration and health in Palermo, and the Biannial Congress of the European Society for Health and Medical Sociology (ESHMS) in Lisbon.

To conclude, through all our pedagogical resources, we offer you the chance to step out of your comfort zone and start questioning yourself about your cultural identity and the approach to diversity in your daily work. Stop being politically correct with yourself, discover your sensitive zones and develop strategies for more conscious and effective intercultural interactions!

Heading towards the end of the project, health professionals from the six partner countries have the chance to take part in a mobility experience to learn new methodologies and exchange good practices with colleagues on diversity management and intercultural communication.

The upcoming blended mobility will take place in Budapest (Hungary)on occasion of the final event of the project that will be hosted at the Conference Center of the Central European University.

The event combines an Interdisciplinary International Conference (2-3 July) to explore various intersectional areas of medicine, anthropology and migration, and three training days (4-5-6 July) where parallel workshops will allow participants to get familiar with the Healthy Diversity methodology and to test some training activities in relation to diversity in encountering patients, the development of practical competences for working in intercultural teams and diversity management skills in healthcare institutions.

The Training for healthcare professionals is complementary to the Conference, but it is anyway possible to take part just in the Conference.

For more information on the conference programme and registration, click here.

There are still some places available!

Eligibility requirements and costs (just for the people taking part in the international mobility): Participants must be professionals in the healthcare sector aged 18 or above (no age limits) and have a full working proficiency in English. They are expected to attend both the Conference (2-3 July) and the training (4-5-6 July).

Travel costs, food, accommodation and the activities and material provided during the training are covered by the programme.

For information on the blended mobility in Budapest, please contact the project partner in your country:

The HEALTHY DIVERSITY final event combines an Interdisciplinary International Conference (2-3 July) to explore various intersectional areas of medicine, anthropology and migration, and three training days (4-5-6 July) which will allow participants to get familiar with the Healthy Diversity methodology and training resources.
The Training for healthcare professionals is complementary to the Conference and it is free to conference participants up to the limit of available places.

The Patient of the New Millennium: An Interdisciplinary International Conference

2-3 July 2018 – The conference languages are English and Hungarian (simultaneous translation)

Why a conference on this topic?

We are well ahead in the 21st century. Looking back on the past 20 years the distance separating us from the last millennium seems already enormous and it is growing every day. Everything changes rapidly in our societies, and these changes have far reaching consequences on our understanding of health, healing and on what we expect from the health system. One trend that seems to clearly emerge is that the sharp dividing line that separates medicine from other disciplines in general, and from social sciences in particular, looks increasingly blurred. On the pretext of presenting a European project around the topic of “Healthy Diversity” we propose to visit three border areas of medicine, the development of which, we believe, will have an important impact on the encounter between patients and medicine in the near future. We will discuss the following themes:

Medicalisation of society – Demedicalisation of medicine

Medicalization, the well-known phenomena first described by the Austrian philosopher Ivan Illich in the mid-70’s, undoubtedly has more actuality than ever before. On the one hand, people tend to rely heavily on solutions offered by the flourishing medical technology, thus being more and more dependent on it. On the other hand, due to various changes in our societies (like democratization of knowledge and individualization), patients would like to keep more control over their own bodies in the schematized and industrialized structures of health care institutions. Furthermore, reductionist biomedical approaches seem to fail to satisfy the humanistic needs of these patients. These oppositional tendencies create tangible tension provoking new answers from medical as well as non-medical scenes.

Unhealthy Societies: inequalities and health in welfare societies

It has been long known that socioeconomic status (SES) or sociocultural conditions (SCC) have a great impact on the health status of a given population. However, new forms of inequalities have been arising in the new millennium due to globalizing processes (risk distribution, different mobility patterns, climatic changes), as well as technological advancements (digital poverty, rarefying social relations), which represent new challenges to medicine as well. Studies have convincingly shown that inequality as such blocks health condition improvements on a societal level. Demographic, ecological and political research categorically questions the possibility of sustainability in the near future unless we intervene on inequalities. The field of medicine cannot shy away from these questions either.

Healthy or unhealthy diversity? dealing with sociocultural diversity in the health systems

Meeting with a doctor is almost always a sensitive moment for all of us as it may have a direct impact on our well-being. This encounter involves at least three parties: the institution, the doctor and the patient. It is becoming more and more usual that the three actors represent radically different sociocultural identities. Although the increasingly mechanistic protocols used in the health system ignore it, interpersonal relations have an important role in the healing procedure. But what happens when the patient and the health worker do not understand each other? How to establish the necessary trust if the actors in the best case totally ignore the world in which the other lives, in the worst case they are full with stereotypes and prejudices? Different initiatives address this problem all over Europe, (intercultural trainings for health professionals, Migrant Friendly Hospitals, EquiHealth – IOM, Nowhereland, etc.), but there is clearly still place here for more imagination and innovation.

Besides the three themes, we will present all the project pedagogical resources developed by the partnership as well as some good practices from the partner countries.

The format of the conference will include key note presentations and round table discussions, allowing participants to actively take part in the debates.

International training on the intersections of Health and Society

The Healthy Diversity methodology

The project activities are based on the method of Critical Incidents developed by the French social psychologist Margalit Cohen-Emerique, that proposes a resourceful strategy to uncover the set of cultural norms, values and behaviours that people belonging to the same culture tend to take for granted (e.g. gender roles, rationality, ideas about concepts like life or wellbeing). Through lifting the often negative emotional haze surrounding intercultural misunderstanding, this methodology helps to become more aware of the illusion of our own cultural neutrality and invites us to explore the cultural reference frames in a more objective way, opening up a margin for negotiation where prejudice has a lesser role to play.

]]>http://healthydiversity.eu/conference-budapest/feed/0Cultural shocks at the University of Rome “La Sapienza”http://healthydiversity.eu/cultural-shocks-at-the-university-of-rome-la-sapienza/
http://healthydiversity.eu/cultural-shocks-at-the-university-of-rome-la-sapienza/#respondWed, 25 Apr 2018 10:47:17 +0000http://healthydiversity.eu/?p=1640On occasion of the annual conference on intercultural pedagogy organised by the intercultural training organisation Fondazione InterCammini at the University “La Sapienza” in Rome, on April 13th, the Italian partner CESIE was invited to present the Healthy Diversity project and to share its experience with the Critical Incidents methodology through a lecture and a workshop on the methodology (Programme – ita only).

In fact, besides the Healthy Diversity project, CESIE and other partners had previously had the chance to work on the cultural shock methodology through the projects BODY (Culture, body, gender and sexuality in adult training) and BODI (Cultural diversity, body, gender, health in early childhood education). Such experiences have indeed represented a unique chance to explore and work at the local level on important and controversial themes.

During the decentration workshop with images, participants were guided through the exploration of the feelings associated to different images, reflecting also on the values and the systems of values behind the elicited emotions. Cultural shocks, in fact, generally occur around “sensitive zones”, i.e. domains which are particularly important in the cultural framework of an individual, and they are also associated to emotional reactions, which can be either positive or negative.

Since diversity of both patients and staff working in health care is a reality in most European countries, intercultural competence of health care professionals is an essential skill ensuring quality care for all patients. Conflicts that may arise due to differing concepts of health, varying communicational preferences or core values held by patients and staff need to be addressed and dealt with in a sensitive manner. Thus, professionals are often faced with questions like:

Does my patient understand the illness?

Can I confidently distinguish cultural/personal or clinical motives behind a patient’s behaviour?

Am I aware of cultural taboos that can affect his/her reception of the treatment proposed?

Which information do I have to give the patient for him/her to feel safe?

At the same time, health professionals are highly pressed for time and have little opportunity to develop their intercultural skills.

The Healthy Diversity project has recently finalised a modular training programme for health professionals, that was tested with 21 participants during a Training Week in Palermo (June 2017).

The training is easily adapted to the specific training needs and time constraints of health care professionals, and is based upon anthropological, psychological, and sociological knowledge about diversity and intercultural communication applied to the health and social care sector. It is intersectional but has its main roots in medical anthropology. Participants are introduced to diversity in the health sector, they learn about diversity in encountering patients and focus on critical incidents experienced in professional practice. Further, intercultural communication and negotiation skills are addressed, as well as working in intercultural teams and diversity management.

Besides the material for face-to-face training activities, the Healthy Diversity partnership is also working on an online course aimed atguiding health professionals through the project’s pedagogical resources in an interactive, flexible and personalized way. The online course will be launched on occasion of the final conference in July.

Last January the Healthy Diversity partnership met again in Copenhagen for a transnational meeting that also offered the chance to discuss two of the Danish good practices with the real protagonists.

On the first day, Naveed Baig, academician and imam, illustrated the activities and the mission of the Ethnic resource-team, which consists of twenty people of different age and with different ethnic and religious background, who provide interpretation and cultural mediation services in hospitals of the Danish Capital Region. They are selected according to language and soft skills, experience and specific competencies in crisis psychology and counselling.

The second good practice, the Neighbourhood Mothers, was presented by Laura Yde, who shared the local experience of this mainly volunteer project aimed at creating a bridge system between women and communities and public authorities. The team in Copenhagen mostly works with mothers whom public agencies do not find easy to engage with (especially from migration background and/or in disadvantaged districts). Thanks to the project they receive training and are then expected to engage other women, becoming a sort of focal points on the territory.

For the other good practices identified and analysed as part of the project activity in the six partner countries, we invite you to explore the Good Practice Collection consisting of:

A Collection of Good Practices from the healthcare sector around Europe, offering short and overview introductions to 20 different good practice examples, as collected by the project partners from various types of healthcare institutions.

The Healthy Diversity Assessment Tool for implementation and self-assessment of projects and new efforts aimed at the improvement of diversity management and intercultural communication and competence in the healthcare sector. It provides and guides a step-by-step development and analysis process, which ensures the necessary consistency between aims, objectives, target group requirements, methods and follow-up assessments of results, effect and impact. Thus, the Assessment Tool presents concrete examples on how to be exact in the formulation of all stages in the overall chain from implementation to final results and evidence of impact in accordance with success indicators. For further illustration of the functioning, the Assessment Tool presents concrete examples of European good practices from the healthcare sector, as reviewed and analyzed by the tool.

A Catalogue of legal frameworks for diversity promoting healthcare services, as placed in the intersection between health policies and integration policies within the partner countries.

The incident

I was treating a patient within her own home and they did not want to have any interaction with dressings or medications. At first I was frustrated and I was unsure of how to treat this patient, when I asked why, they mentioned that they followed the Pagan belief. I then went and did some research at to what natural remedies I could use and then I talked to them about what they would like to happen and the alternative options I had found, they were happy with the remedies and I was able to use this for her treatment.

1. Identities of the actors in the situation

Narrator: Female Podiatrist in her 20s/30s, white British, married with 2 children, church of England, sociable, union rep, university qualified, lives in house with average cleanliness, online shopper, mentally stable, reserved, modest.

Patient – Retired university lecturer, female, single, white British, no family, no friends, Pagan, lesbian, chose to be socially isolated, lives in flat, spent a lot of time in bed / living room, healthy.

2. Context of the situation

The situation takes place during a professional home visit, where care usually took place in the living room. The living space was cluttered and very untidy, the patient would usually be in her night clothes and not very covered up. The patient had her bed in her living room too, as she spent most of her time in bed in her living room.

3. Emotional reaction

Frustration – due to noncompliance, cross, anxiety – due to not knowing about patient’s religion / beliefs, curiosity. The podiatrist was younger at the time and felt there was importance in following the rules and processes and this was something new to her so she was anxious about how to deal with this situation.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

Importance of a social network – The narrator believes it is important to socialise and have a strong social network of friends and family.

Active coping – problem solver – The narrator believes that regarding work issues if there is a problem with the patient she will find a way to ensure that she finds a solution so she is able to carry out her treatment and the patient is happy and cooperative.

Value of diversity – the narrator values difference and diversity and therefore was happy to find a solution to meet the needs of her patient.

Respect of religion – although the narrator places more importance on health and wellbeing than religion, she also makes extra effort to find a treatment that is in accordance with the religious practices of the patient and that the patient will accept rather than give up on the treatment all together.

Tidiness – the narrator found it hard to understand why the patient kept her bed in her living room which was untidy but her kitchen and bathroom were spotless, showed the narrator that the patients spent much of her time in the living room.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The narrator felt the other person was very religious and follow their religious beliefs. Found it strange that the patient used to be a lecturer and now chose to be so socially isolated. The narrator assumed that if someone was highly educated and used to be a lecturer then they would have a good social network. Found it difficult to understand why the patient would put their bed in their living room and that their living room was so untidy and messy yet other parts of the house like the kitchen and bathroom were spotless.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

Importance of religion –the recognition of the divine in nature is at the heart of Pagan belief. Pagans are deeply aware of the natural world and see the power of the divine in the ongoing cycle of life and death. Most Pagans are eco-friendly, seeking to live in a way that minimises harm to the natural environment.

Isolation – Maybe due to her beliefs she felt that people would not understand her religion and chose to therefore keep herself isolated. As she had no friends or family this makes socialising even more challenging. The patient kept her bed in the living room close to her Television as that was her form of human contact.

Education – Highly education and a previous university lecturer, is interested in the world around as she would often watch programmes on current affairs.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

The experience was initially negative and frustrating but turned into positive as the narrator was able to come up with solutions to be able to treat the patient but also respect the religious beliefs at the same time. The professional practice should be able to be flexible and find solutions if cultural differences arise. Finding a way to articulate and connect the objectives of the medical treatment with the cultural practices of the professional is the very essence of intercultural negotiation. A key moment of this negotiation is the recognition of the values / preferences of the patient as valid and important. This incident is a very nice illustration to the capacity of discovering the rationality of the other and of negotiation.

The incident

A child in the care of community nurses died (the death was expected, prepared for and managed well). In the days following, a nurse visited the family to offer support and remove equipment.

The family had prepared a room, with the child’s body on view where food was left. The nurse was invited to come and spend time in the room, and share the food. She found this very unsettling, and the fact that the food was of a type she wasn’t used to eating added to her discomfort.

1. Identities of the actors in the situation

Child (deceased, 7/8 years, female, Asian, terminally ill, end of life care).

Family (Asian, parents & grandparents, religion unknown) Asian from where – South Asian (that’s all we know).

2. Context of the situation

Home of the family – child’s bedroom. Pre agreed visiting time. The child’s body was on view and there was catering a refreshments also in the room. Religion of the boy and family was unknown.

3. Emotional reaction

Unsettled as the child was there 2 days after death. Uneasy due to the hygiene factor that there was food in the room with a child’s body. Anxious that they wanted her to eat the food of which was unknown to her, didn’t want to upset or offend the family.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

Separation of the dead and the living: in the narrator’s practice of Christianity the body would go straight to the undertakers and not on display until the funeral. It is not usual for children to have an open casket due to how distressing this would be, let alone leaving the body on display for two days.

Individualism: Even if there is a viewing, lots of people would not surround a body and people would visit the body in private isolation or small groups. Large groups of people surrounding a small child was very unusual for the narrator.

Hygiene – food should not be in the same room or area as a dead body. On a more spiritual register: the place of food is with the living, not to be confused with the realm of the dead.

Politeness and respect for other cultures – Narrator didn’t want to upset the family and therefore entered the room and tried some of the food despite how uncomfortable this felt. Guests often feel that refusing sharing a meal would be seen as an offence.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

Confused as to the purpose of this ritual.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

Rites of separation and grieving process- cultures differ in how the parting from a dead person is ritualized. In modern western cultures the dead body is parted quite soon from the world of the living, but in many other cultures there is a longer period, possibly lasting days of “coexistence” between the living family members and the body of the dead person.

Tendency towards collectivism / interdependence the parting is not seen as a private issue but one shared with friends and family.

Food during funeral: it is traditional even in some modern Western societies to have a joint meal with the close family and friends after a funeral. The sharing of the food can have many meanings: reinforcing the social connections, compassion with the grieving, and sometimes also proving for the living that they are alive. However, in the west, sharing food usually takes place in a separate space, possibly a restaurant and not in the same space of the viewing. In some religious

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

Death rituals vary from culture to culture, and because death is one of the most sensitive themes we can imagine it is not a surprise that mourning rituals differing from our own can trigger strong emotional reactions. Mostly because they break from the rituals we’re used to and they are no more able to protect us from the awareness of the inevitability of our own death.

A second issue highlighted by the case concerns the respect of the limits of the professionals. Often professionals feel obliged to accept such invitations, as in this case where the protagonist was supporting as a Clinical Supervisor – even when the invitation threatens of breaking one’s own limits. Limits in intercultural situations are very important to get acquainted with and to protect to some extent. Regularly disregarding one’s personal and cultural limits brings the risk of burn-out.

The narrator of the incident learning from her own reaction decided to have conversation with colleagues that would attend the viewing, before they enter the house to make them aware of the environment and avoid similar culture shock experiences.

The incident

My mother is Sikh, in her 80s, her main language is Punjabi and she has limited English. She was in hospital when the critical incident took place. My main issue arose when the nurses were giving morning medication to patients very early, according to the medication sheet / schedule.

However, my mother who is a baptised Sikh will usually, after she gets up, have a shower / clean herself, then perform her daily prayers and only after that will she have something to eat or drink.

Without understanding this culture, the elderly woman, who cannot explain this to hospital staff, refused to have medication at that time. Staff assumed the medication was being refused and insist on this being taken immediately. The problem was not the patient taking the medication, but the timing of when she was able to take the medication.

Carers were not fitting around her needs, e.g. breakfast at 9.00am which is too late as she is diabetic. The rules are that medication is at 8.00am which is set in stone. Nursing staff changed every day so the family have to go through their mother’s needs every day. Staff are under pressure to give everyone their medication by a certain time every day. No Punjabi speakers available and the mother usually responds yes by nodding to any question as she is unable to understand what they are saying to her.

1. Identities of the actors in the situation

Narrator: son of a patient, male, 60s, married, father, Sikh, Religious, Chair of the Warwick District Faith Forum, Active member of the community.

The patient: mother of the narrator, female, Sikh, in her 80s has stomach issues, bleeding internally, prone to liver infection, care package lacking, and family support very important and has little English and her main language is Punjabi.

Healthcare professionals caring for his elderly mother in hospital.

2. Context of the situation

Hospital setting in a shared ward between patient and hospital staff.

3. Emotional reaction

Stress and frustration amongst the family members who have to repeat the same thing every day to new nurses due to the lack of continuity amongst the staff. Her needs do not seem to be recorded for consistency. The Family feel the stress is impacting on her health / wellbeing.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

Importance of valuing a patient’s religion – the narrator believes the nurses should take into account the patients religion and what she can and can’t do. This should be asked of the patient when she is admitted.

Diversity management: it should be the hospital’s responsibility to ensure that they can communicate with all patients, even those whose command of English is insufficient for reliable communication. The nurses should make sure she understands the questions being asked and use an interpreter for her.

Extra efforts should be made to adapt and articulate the treatment with the religious preferences of the patients.

Professionalism – the narrator assumes that it is professional conduct to have handover notes and something as important as when the patient can have her medicine should be included. This should not have to be repeated on a daily basis.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The narrator had a negative image of the nurses that were taking care of his mother.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

Importance of routine – it is procedure to ensure all patients receive medication at the same time to ensure continuity and are under strict guidelines to ensure timings are adhered to.

Stress – due to staff shortages staff are under more pressure to ensure to care for patients with limited resources.

Importance of handover notes – the nurses value the importance of a handover but due to time restrictions these may not always be as comprehensive as they should be.

Diverse patients – staff deal with a diverse range of patients with different languages and it is not always possible to find interpreters and they therefore understand that when the patient nods her head she is agreeing and if she refuses medication, this is because she does not want to take it.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

The training needs of the organisation are problematic as well as their personal approach to individual healthcare. They need to see patients as individuals with individual needs rather than just as patients with a one size fits all philosophy. There is a need for the use of mentors and a positive / friendly approach to patients. Other issues include:

The code of conduct as a nurse, nurses to be more accountable and ensure that appropriate handover is done to minimize patients having to repeat themselves.

Hospitals need to establish if patients have language barriers at the admission stage and note to ensure interpreters are available.